"Puberty blocking in transgender adolescents: How well-informed and open to change are the choices made at young age?"
Background
^In international clinical guidelines the treatment with puberty blockers (PB) is described as an extended diagnostic phase in which the pubertal adolescents are provided time to make a balanced decision regarding gender affirming medical treatments [1;2]. Even though treatment with PB is described as an extended diagnostic phase, many transgender adolescents seem to experience PB as the first ‘necessary’ medical step of a seemingly indisputable trajectory with permanent physical changes (through gender affirming hormones and/or surgeries) in the end. If treatment with PB is seen as the first step to take in gender affirming treatment, very young children (from the age of 10) make a decision with life-long consequences, which may include reduced opportunities for fertility. Most adolescents that start suppression, continue with the (partially) irreversible steps of sex hormones and surgeries.
However, concerns have been raised about the risk of regret, as gender identity could fluctuate during adolescence. Furthermore there are worries about the impact of PB on physical, cognitive and psychosocial development and the development of a consistent gender identity [4]. An important issue in this regard is whether minors at such young age are capable of making decisions about treatment with such consequences [5]. One of the eligibility criteria for adolescents for treatment with PB according to the international guidelines is that the adolescent should have sufficient mental capacity to give informed consent to this treatment [1]. Children’s competence to consent to treatment is a major issue in pediatric ethics, especially when it concerns consent for far-reaching treatments with possible side-effects. Up until now, little is known regarding child’s competence except that it often proved difficult to assess a child’s competence in clinical settings [6;7]. Nor is there empirical evidence on transgender children’s or adolescents’ competence to consent to treatment with PB. The aim of our study is to improve the decision making process in transgender adolescents regarding PB. The objectives are to: 1) examine whether treatment with PB is considered an extended diagnostic phase or the first ‘necessary’ medical step in the gender affirming trajectory by transgender adolescents themselves; and 2) examine how transgender adolescents themselves consider their competence to consent to treatment with PB.^
Methods
Semi-structured interviews will be conducted to identify considerations of transgender adolescents in the Netherlands regarding treatment with PB. About 10 to 15 adolescents who are treated with PB and gender affirming hormones will be interviewed looking back on their treatment. Data collection will continue as long as new information comes up (data saturation).
Results and Conclusions
Preliminary results of these interviews will be presented. With this study we expect insight into whether treatment with PB is considered an extended diagnostic phase or the first ‘necessary’ medical step in the gender affirming trajectory. Secondly we expect to present how adolescents think about their capacities to make decisions on PB. Based on these results, recommendations for clinical care will be given
OK so I'm glad these questions are at least being asked, but this "study" seems to be saying they're going to take 10 teenagers and ask them if they think they're mature enough to make life changing medical choices and then make clinical recommendations based on their answers. Am I the only one to spot the flaw in this plan?
Also this: concerns have been raised about the risk of regret, as gender identity could fluctuate during adolescence. Furthermore there are worries about the impact of PB on physical, cognitive and psychosocial development and the development of a consistent gender identity Maybe someone could have asked those fucking questions before making a children's TV show about how super safe and reversible and not a big deal pubity blockers are and screening it on cbeebies!